Patient outcomes and operational efficiency supported by rubber flooring

by Katie Daniel | October 12, 2017 12:52 pm

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by Sandra Soraci, EDAC, LEED AP, NCIDQ, and Tasha Hughes
Not long ago, design drivers focused on aesthetics and price when it came to the selection and specification of floorcoverings in healthcare facilities. Floors are a vital part of the palette supporting interior designers’ visions and allowing them to adhere to project budget constraints. Decisions pertaining to flooring and its various performance characteristics have evolved, and are now far more complex, often guided by an evidence-based design strategy acknowledging a link between the physical environment, materials specified, and patient and staff outcomes. This strategy becomes even more important given a portion of the health system’s reimbursement is tied to patient outcomes.

Floorcoverings are now being evaluated according to a new set of design and performance criteria. They still need to adhere to budget guidelines, and must still have aesthetic appeal, since they contribute to visitors’ first impressions of a space and shape opinions about the quality of care. However, they must also support clinical efficiency, safety, and operational optimization via performance characteristics impacting patients and staff.

As this change in the selection process has evolved, premium rubber flooring has remained a strong choice. It addresses barriers in the built environment and offers multiple performance characteristics to healthcare professionals and their patients.

Composition materials and differences in manufacturing processes result in floors that differ in appearance and ability to meet the performance demands of a healthcare facility. Premium rubber flooring combines high-quality rubber,
raw mineral materials extracted from natural deposits, and environmentally compatible color pigments with manufacturing processes that create a single homogenous product free of layers. Together, these materials and processes ensure the safety, durability, surface density, stain resistance, maintenance, and reparability characterizing floors that contribute to positive patient and staff outcomes.

Flooring contributes to performance improvement goals
In a 2012 research study, the Center for Health Design identified eight performance characteristics defining the impact flooring has on operations, health, safety, and wellness. (For more, see 2012’s “Achieving EBD Goals Through Flooring Selection and Design” by U. Nanda, E. Malone, and A. Joseph with the Center for Health Design.)

This evidence-based design approach defined how flooring can reduce:

• slips, trips, and falls;
• patient and staff injuries associated with falls;
• noise levels;
• staff fatigue;
• surface contamination and potential risk of healthcare-acquired infections (HAIs); and
• complaints about indoor air quality (IAQ).

Rubber floors can represent the best return on investment (ROI) for many healthcare projects.

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Rubber flooring reduces impact of noise
Rubber flooring also reduces the negative impact of noise. As the foundation of the built environment, flooring plays a primary role in transferring the noise generated by hospital alarms, printers, chair casters, rolling equipment, footsteps created by hard-soled shoes, and cleaning equipment (steam-cleaning of rubber floors is much quieter). All contribute significantly to sound levels in the healing environment, which have long been a source of complaints.

Evidence-based research studies show noise also has a direct, measurable, and negative impact on healing. (Visit www.sciencedirect.com/science/article/pii/S0360132312001758[3] and www.interiorsandsources.com/article-details/articleid/20950/viewall/true?title=the%20art%20of%20healing%20spaces%20that%20perform[4] for more.) Noise can cause sleep disruption, which affects wound healing and increases the need for medication and the length of stay. So pervasive is the issue of noise, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey asks, “During this hospital stay, how often was the area around your room quiet at night?” This question has frequently received the lowest patient scores in health systems. (For more on acoustics in hospitals, visit www.healthcaredesignmagazine.com/architecture/quiet-design-exploring-hcahps-findings[5].)

Noise has also been associated with undue stressors that negatively impact caregivers and can be error-provoking. It can irritate nurses, increase cognitive fatigue, hasten emotional exhaustion and burnout, and contribute to retention issues and communication difficulties, among other problems.

Evidence-based research suggests among common healthcare flooring surfaces, rubber generally produces the least impact noise. (This research can be found in B. Davenny’s January 2010 piece, “Auditory Assistance: Strategies to reduce hospital noise problems” in Health Facilities Management.) Absorbent, acoustic rubber flooring can reduce footfall sound. Those tasked with specifying a floorcovering should properly compare impact insulation class (IIC) and delta impact insulation classification (∆IIC) values among various resilient flooring manufacturers.

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Fatigue impacts staff performance
The cause of exhaustion among staff is not limited to noise. For caregivers and members of the housekeeping staff, hard, unforgiving flooring surfaces can perpetuate physical fatigue and negatively impact performance by limiting the ability to perform personal and work-related activities. Musculoskeletal injuries are chronic in nature, and the result can be reduced productivity and increased absenteeism, opportunities for errors, and costs associated with workers’ compensation, retraining, and retention.

Premium rubber is especially resilient, easing the stress of walking and standing while ensuring comfort underfoot and allowing nurses to concentrate on their patients rather than the pain in their feet.

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HAIs and maintenance needs
When it comes to creating safer spaces, healthcare settings demand flooring that can be efficiently cleaned and disinfected. A Centers for Disease Control and Prevention (CDC) survey, based on a large sample of U.S. acute-care hospitals, found one in 25 hospital patients had at least one healthcare-acquired infection.  (For more, visit www.cdc.gov/hai/surveillance/index.html[8].) A separate CDC study of medical costs estimates the overall annual direct medical costs of HAIs to U.S. hospitals ranges from $35.7 to $45 billion. (More on this study is available at www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf[9].) Thus, it is important to note the strong performance characteristics of extremely dense, closed-surface premium rubber flooring. This flooring is inherently dirt-repellent and neither serves as a media to microorganisms, nor encourages or produces bacteria. This allows it to support the drivers of infection control in the built environment.

Additionally, premium rubber flooring does not contain any added antimicrobials, which means the flooring is free of pesticides and chemicals. Antimicrobials have two major uses:

• to disinfect, sanitize, reduce, or mitigate the growth or development of microbiological organisms; and
• to protect inanimate objects (e.g. floors and walls) from contamination, fouling, or deterioration caused by bacteria, viruses, fungi, protozoa, or algae.

However, in a 2003 study, the Centers for Disease Control (CDC) stated, “There is no evidence to suggest that products with added antimicrobials prevent disease.” (Visit healthybuilding.net/news/2014/01/08/fda-acts-on-antimicrobials[10] to read more.)

Following up on this report, Kaiser Permanente, an integrated managed care consortium based in Oakland, California, consulted with infectious-disease experts. The infection prevention community agreed with CDC’s findings properly cleaning and disinfecting surfaces will kill pathogens effectively and mitigate the risk of spreading HAIs. As a result, in 2015 Kaiser banned 15 antimicrobial chemicals and elements as additives to furnishings and finishes in the built environment as a component of its Environmentally Preferred Purchasing (EPP) program. (For more, visit is available at share.kaiserpermanente.org/article/kaiser-permanente-rejects-antimicrobials-for-infection-control[11].)

In the absence of these antimicrobials, proper maintenance of floorcoverings becomes even more critical. Maintenance is a key area where specification of premium rubber flooring improves safety, as well as clinical and operational optimization. An automatic scrubber can clean and buff rubber floors rapidly by applying water to the floor via a scrubbing pad and then squeegeeing the water off the floor, leaving a clean, dry floor in about the same amount of time it takes to mop. This process eliminates the need for chemicals in cleaning and improves IAQ in support of health and wellness.

Further, premium rubber floors do not require the labor-intensive application of coatings or waxes. The absence of finishes and other chemicals benefits everyone in a healthcare setting, especially those who might be sensitive to smells or suffer from allergies these products aggravate. It also means there will not be a need to move patients or close large areas of a facility for an extended period while floors are cleaned and coatings or waxes are applied and allowed to dry. This is especially important given healthcare is a 24/7, 365-day operation.

Additionally, the introduction of a steam-cleaning system gives facilities and environmental service teams the ability to clean the floor while an area is occupied, increasing flexibility, reducing disruption to clinical work, improving patient perception, and directly impacting HCAHPS scores.

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Improving indoor air quality
In addition to maintenance efficiencies, the elimination of harsh cleaning chemicals, coatings, waxes, and strippers also improves IAQ, which has a direct impact on health and wellness. Flooring selected for healthcare facilities should meet stringent standards for low volatile organic compound (VOC) emission, including Greenguard Gold certification, which utilizes California’s Section 01350 protocol. This certification is actually a higher level than required by Section 01350 or the major green rating systems—it tests for an additional 330 chemicals on top of the 35 required by Section 01350, and includes a total VOC (TVOC) measurement as well.

Improved IAQ, along with reduced noise levels and risk of HAIs, contributes to improved patient, caregiver, and family satisfaction. Meanwhile, an analysis of vinyl composition tile (VCT), sheet vinyl, carpet, rubber, and linoleum flooring conducted by the Florida Hospital Office of Design studied the life-cycle costs of those materials over a 15-year period. (Read more at www.interiorsandsources.com/article-details/articleid/6130/title/rubber-flooring-value-and-beauty-for-the-long-term[13].)

The study found VCT to be the least-expensive ‘first-cost’ material, but its maintenance protocol costs can still be nine to 15 times the cost of the installed floor due to finish requirements and the associated labor required to maintain the product.

The same study found of the products tested, rubber flooring had the lowest cost per area over the 15 years. This fact, along with the material’s performance characteristics, allows rubber floorcovering to offer excellent ROI.

Conclusion
More than a floorcovering, premium rubber flooring is a solution supporting a variety of stakeholders, including specifiers, designers, healthcare administrators, caregivers, and—perhaps most importantly—patients and their families. Premium rubber flooring and its inherent product attributes provide a sound focus on operational optimization, clinical efficiency, and patient/caregiver outcomes, while offering a solution that best supports the link between the physical environment, reimbursement drivers, and patient and caregiver well-being, fostering the human-centered needs in a healthcare environment.

Tasha Hughes is a public relations and marketing specialist for nora systems, an international rubber flooring manufacturer dedicated to developing premium flooring solutions for various commercial markets, including healthcare, education, industry, life science, labs, and public buildings. She can be reached via e-mail at tasha.hughes@nora.com[14].

Sandra Soraci, EDAC, LEED AP, NCIDQ, is the marketing leader, healthcare solutions, for nora systems. She has been a healthcare designer and thought leader for more than 20 years. As a designer, Soraci’s mission is to collaborate with and support the challenges nora’s healthcare partners are faced with. She can be reached via e-mail at sandra.soraci@nora.com[15].

Source URL: https://www.constructionspecifier.com/patient-outcomes-operational-efficiency-supported-rubber-flooring/

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